Effect of local spraying of <i>Pseudomonas aeruginosa</i> injection on recurrent laryngeal nerve after total thyroidectomy and bilateral central lymph node dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Yu , ZENG Cuifang , ZOU Xiuhe , LEI Jianyong , ZHENG Xun , LI Zhihui , GONG Rixiang , ZHU Jingqiang ,  WEI Tao

Department of Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WEI Tao, Email: weitaohxsurgeon@163.com

Keywords：

papillary thyroid cancer; center neck dissection; recurrent laryngeal nerve; Pseudomonas aeruginosa injection; local spraying

DOI：

10.7507/1007-9424.202004004

Video：

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Objective To evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).Methods From Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.Results The two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.Conclusion After total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.

Citation： MA Yu, ZENG Cuifang, ZOU Xiuhe, LEI Jianyong, ZHENG Xun, LI Zhihui, GONG Rixiang, ZHU Jingqiang, WEI Tao. Effect of local spraying of Pseudomonas aeruginosa injection on recurrent laryngeal nerve after total thyroidectomy and bilateral central lymph node dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(12): 1496-1500. doi: 10.7507/1007-9424.202004004 Copy

1.	朱精强, 苏安平. 甲状腺结节手术治疗的合理选择. 中国实用外科杂志, 2015, 35(6): 635-639.
2.	魏涛, 朱信心, 陈锐, 等. 铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的临床分析. 中国普外与基础杂志, 2013, 20(3): 325-327.
3.	Zhang M, Luo F, Zhang Y, et al. Pseudomonas aeruginosa mannose-sensitive hemagglutinin promotes T-cell response via toll-like receptor 4-mediated dendritic cells to slow tumor progression in mice. J Pharmacol Exp Ther, 2014, 349(2): 279-287.
4.	Zhang C, Zhang Z, Wang L, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection treated cytokine-induced killer cells combined with chemotherapy in the treatment of malignancies. Int Immunopharmacol, 2017, 51: 57-65.
5.	牟希亚. 绿脓杆菌甘露糖敏感血凝菌毛株的首次选育建株. 大连医学院学报, 1985, 1: 1-3.
6.	Fass R, van de Walle M, Shiloach A, et al. Use of high density cultures of Escherichia coli for high level production of recombinant Pseudomonas aeruginosa exotoxin A. Appl Microbiol Biotechnol, 1991, 36(1): 65-69.
7.	洪义东, 胡楠, 卞宝祥, 等. 铜绿假单胞菌注射液抗肿瘤作用及其相关机制的研究进展. 中国现代应用药学, 2019, 36(2): 256-259.
8.	Agrawal N, Evasovich MR, Kandil E, et al. Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement. Head Neck, 2017, 39(7): 1269-1279.
9.	张凤华, 贾玉杰. 铜绿假单胞菌注射液辅助治疗恶性肿瘤的应用进展. 大连医科大学学报, 2010, 32(4): 479-482.
10.	Liu XF, Wang L, Qu Y, et al. Effect of the PA-MSHA vaccine on septic serum-induced inflammatory response. Mol Med Rep, 2013, 7(4): 1350-1354.
11.	Hou J, Liu Y, Liu Y, et al. The MSHA strain of Pseudomonas aeruginosa activated TLR pathway and enhanced HIV-1 DNA vaccine immunoreactivity. PLoS One, 2012, 7(10): e47724.
12.	董若凡. 铜绿假单胞菌注射液对宫颈癌术后淋巴液引流的影响. 实用临床医学, 2018, 19(12): 38-39.
13.	Wei T, Liu F, Li ZH, et al. Novel management of intractable cervical chylous fistula with local application of Pseudomonas aeruginosa injection. Otolaryngol Head Neck Surg, 2015, 153(4): 561-565.
14.	Chen Q, Chen Y, Su A, et al. Ultrasound-guided percutaneous injection of Pseudomonas aeruginosa-mannose sensitive hemagglutinin for treatment of chyle fistula following neck dissection: two case reports. Medicine (Baltimore), 2020, 99(5): e18816.
15.	Chen Q, Zou X, Ma Y, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection therapy for the treatment of chyle fistula following neck dissection. Head & Neck, 2020, 42(4): 725-731.
16.	訾聃, 何丽萍, 杨英捷, 等. 铜绿假单胞菌注射液局部喷洒及皮下注射对宫颈癌患者术后淋巴液引流量的影响. 山东医药, 2011, 51(34): 80-81.
17.	马富懿, 王礼泉, 王昌亮, 等. 铜绿假单胞菌注射液在乳腺癌切除术后皮下积液中的临床应用. 中华肿瘤防治杂志, 2009, 16(14): 1111-1112, 1119.
18.	谢凡, 张家洪. 铜绿假单胞菌注射液胸腔灌注治疗恶性胸腔积液的临床分析. 临床肺科杂志, 2016, 21(3): 528-530.
19.	朱亚芳, 魏金芝, 顾洪兵. 铜绿假单胞菌注射液腔内注入治疗 23 例恶性心包积液的临床观察. 现代肿瘤医学, 2011, 19(12): 2458-2459.
20.	王北, 吴应盛, 张珉. 铜绿假单胞菌注射液治疗 Whipple 术后淋巴漏的临床分析. 中国现代药物应用, 2015, 9(19): 150-151.
21.	Genpeng L, Jinen S, Tao W, et al. Intraoperative application of inactivated Pseudomonas aeruginosa in patients undergoing lateral neck dissection for metastatic thyroid cancer: A randomized, parallel group, placebo-controlled trial. Surgery, 2020, 168(2): 340-346.
22.	Roh JL, Yoon YH, Park CI. Chyle leakage in patients undergoing thyroidectomy plus central neck dissection for differentiated papillary thyroid carcinoma. Ann Surg Oncol, 2008, 15(9): 2576-2580.
23.	Park I, Her N, Choe JH, et al. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck, 2018, 40(1): 7-15.
24.	Campisi CC, Boccardo F, Piazza C, et al. Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 150-156.

1. 朱精强, 苏安平. 甲状腺结节手术治疗的合理选择. 中国实用外科杂志, 2015, 35(6): 635-639.
2. 魏涛, 朱信心, 陈锐, 等. 铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的临床分析. 中国普外与基础杂志, 2013, 20(3): 325-327.
3. Zhang M, Luo F, Zhang Y, et al. Pseudomonas aeruginosa mannose-sensitive hemagglutinin promotes T-cell response via toll-like receptor 4-mediated dendritic cells to slow tumor progression in mice. J Pharmacol Exp Ther, 2014, 349(2): 279-287.
4. Zhang C, Zhang Z, Wang L, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection treated cytokine-induced killer cells combined with chemotherapy in the treatment of malignancies. Int Immunopharmacol, 2017, 51: 57-65.
5. 牟希亚. 绿脓杆菌甘露糖敏感血凝菌毛株的首次选育建株. 大连医学院学报, 1985, 1: 1-3.
6. Fass R, van de Walle M, Shiloach A, et al. Use of high density cultures of Escherichia coli for high level production of recombinant Pseudomonas aeruginosa exotoxin A. Appl Microbiol Biotechnol, 1991, 36(1): 65-69.
7. 洪义东, 胡楠, 卞宝祥, 等. 铜绿假单胞菌注射液抗肿瘤作用及其相关机制的研究进展. 中国现代应用药学, 2019, 36(2): 256-259.
8. Agrawal N, Evasovich MR, Kandil E, et al. Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement. Head Neck, 2017, 39(7): 1269-1279.
9. 张凤华, 贾玉杰. 铜绿假单胞菌注射液辅助治疗恶性肿瘤的应用进展. 大连医科大学学报, 2010, 32(4): 479-482.
10. Liu XF, Wang L, Qu Y, et al. Effect of the PA-MSHA vaccine on septic serum-induced inflammatory response. Mol Med Rep, 2013, 7(4): 1350-1354.
11. Hou J, Liu Y, Liu Y, et al. The MSHA strain of Pseudomonas aeruginosa activated TLR pathway and enhanced HIV-1 DNA vaccine immunoreactivity. PLoS One, 2012, 7(10): e47724.
12. 董若凡. 铜绿假单胞菌注射液对宫颈癌术后淋巴液引流的影响. 实用临床医学, 2018, 19(12): 38-39.
13. Wei T, Liu F, Li ZH, et al. Novel management of intractable cervical chylous fistula with local application of Pseudomonas aeruginosa injection. Otolaryngol Head Neck Surg, 2015, 153(4): 561-565.
14. Chen Q, Chen Y, Su A, et al. Ultrasound-guided percutaneous injection of Pseudomonas aeruginosa-mannose sensitive hemagglutinin for treatment of chyle fistula following neck dissection: two case reports. Medicine (Baltimore), 2020, 99(5): e18816.
15. Chen Q, Zou X, Ma Y, et al. Pseudomonas aeruginosa-mannose sensitive hemagglutinin injection therapy for the treatment of chyle fistula following neck dissection. Head & Neck, 2020, 42(4): 725-731.
16. 訾聃, 何丽萍, 杨英捷, 等. 铜绿假单胞菌注射液局部喷洒及皮下注射对宫颈癌患者术后淋巴液引流量的影响. 山东医药, 2011, 51(34): 80-81.
17. 马富懿, 王礼泉, 王昌亮, 等. 铜绿假单胞菌注射液在乳腺癌切除术后皮下积液中的临床应用. 中华肿瘤防治杂志, 2009, 16(14): 1111-1112, 1119.
18. 谢凡, 张家洪. 铜绿假单胞菌注射液胸腔灌注治疗恶性胸腔积液的临床分析. 临床肺科杂志, 2016, 21(3): 528-530.
19. 朱亚芳, 魏金芝, 顾洪兵. 铜绿假单胞菌注射液腔内注入治疗 23 例恶性心包积液的临床观察. 现代肿瘤医学, 2011, 19(12): 2458-2459.
20. 王北, 吴应盛, 张珉. 铜绿假单胞菌注射液治疗 Whipple 术后淋巴漏的临床分析. 中国现代药物应用, 2015, 9(19): 150-151.
21. Genpeng L, Jinen S, Tao W, et al. Intraoperative application of inactivated Pseudomonas aeruginosa in patients undergoing lateral neck dissection for metastatic thyroid cancer: A randomized, parallel group, placebo-controlled trial. Surgery, 2020, 168(2): 340-346.
22. Roh JL, Yoon YH, Park CI. Chyle leakage in patients undergoing thyroidectomy plus central neck dissection for differentiated papillary thyroid carcinoma. Ann Surg Oncol, 2008, 15(9): 2576-2580.
23. Park I, Her N, Choe JH, et al. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck, 2018, 40(1): 7-15.
24. Campisi CC, Boccardo F, Piazza C, et al. Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 150-156.

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Effect of local spraying of Pseudomonas aeruginosa injection on recurrent laryngeal nerve after total thyroidectomy and bilateral central lymph node dissection

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